Scottish Academy Report on ‘Learnings from Serious Failings in Care’

The Academy of Medical Royal Colleges in Scotland has today (10 July 2015) published a series of major recommendations aimed at addressing systemic failings in NHS care in Scotland, evidenced in recent reports on hospital deficiencies, which it believes have been predominantly caused by the failure of clinical staff and NHS management to work together to deliver improved healthcare.

Central to the recommendations are the urgent need to engender more effective team working, to place quality of care ahead of targets, to ensure appropriate staffing levels and to end the culture of “learned helplessness” experienced by staff when poor standards of patient care are condoned and perpetuated due to a combination of pressures.

Commenting on the Academy's report, President of The Royal College of Surgeons of Edinburgh and Chair of the Academy of Medical Royal Colleges & Faculties in Scotland (‘Scottish Academy’), Mr Ian Ritchie said:

"The purpose of this report is not to denigrate any organisations or individuals. While recognising that a range of quality improvement work has been undertaken since the publication of the reports, we believe that much work remains to be done to improve the quality of care in Scotland.

"We recognise that as professionals we have a responsibility to do more to prevent further failings in care and we have accepted all of the recommendations in this valuable report. However, this cannot be done by any one group. Clinical staff and management must work more effectively together as teams. They must also be supported in doing so by ending the focus on inappropriate targets and making quality of care our over-riding priority."

Key Findings

Key issues which contributed to the serious failings in care include:

poor leadership at all levels (including senior clinical staff and management) resulting in a defective culture, a disconnect between clinical staff and management, inappropriate targets and poor accountability mechanisms;

staff shortages, an inappropriate skills mix on the team, inappropriate use of inexperienced staff or failure to supervise;

poor staff morale and motivation;

poor dealings with patients (inadequate care and poor communication);

inadequate complaints handling (poor feedback and complaints mechanisms and inhibition to whistleblowing); and

limitations of external assessments (remit and nature of the reports, composition of the review teams, inappropriate methodologies, omissions, unclear follow-up and questions of confidentiality and disclosure).

Recommendations

loss of leadership at all levels has been a key feature in many of the recent reports on failing hospitals. The atmosphere within any institution is dictated by those at the top. Caring for and appreciating staff is at the core of this. Emphasising the importance of good communication comes with good leadership. A supportive, listening environment must be created to produce a culture which instils confidence in staff, patients and relatives and in which innovation is encouraged;

quality of care must become the primary influence on patient experience and NHS Boards, a routinely discussed and acted upon agenda item at Board level and the primary indicator of performance;

increased awareness of potential quality vacuums needs to be recognised, being created as a result of not just the imminent closure of a service or hospital but also when there exists the mere possibility. Policymakers also need to be mindful that in instances in which decisions to close hospitals have been reversed, the services may have degraded to a point below the required level to provide safe, quality care. This may also occur when hospitals are kept under constant review;

action needs to be taken by NHS Boards to improve the working culture within the NHS and in particular to address the ‘learned helplessness’ which can be experienced by staff when poor standards of care are condoned and perpetuated due to a combination of organisational and external pressures and a sense that this cannot be changed at an individual level;

the Scottish Government should work together with the Scottish Academy, the General Medical Council and other stakeholders to foster a work culture in the NHS which is free from bullying;

the Scottish Government and NHS Boards should work together to develop minimum, safe staffing levels for all professions in hospital settings, providing the required skills mix and under appropriate supervision, so as to ensure that all patients receive safe and high quality care delivered by appropriately trained and experienced professional staff;

a common methodology should be developed and used nationally for investigating serious failings in NHS care, culture, operational activity/practice and performance to eliminate potential bias, maintain confidence, ensure transparency and consistency, increase triangulation with other available data and to include monitoring and review; and

failings should not be viewed as isolated, localised incidents and reported on without reference to failings in other parts of Scotland and throughout the UK. It is clear such an approach has led to missed opportunities to learn valuable lessons from other parts of the NHS. When Inquiry or Review reports are published and are of national significance, all Boards should be required to demonstrate their compliance with the recommendations.

RCSEd (www.rcsed.ac.uk) was first incorporated in as the Barber Surgeons of Edinburgh in 1505, and is one of the oldest surgical corporations in the world with memberships approaching 25,000 over 100 countries worldwide. The College promotes the highest standards of surgical and dental practice through its examinations, and is also increasingly involved in the provision of surgical training and education, offering the UK’s only Faculty of Surgical Trainers, open to all those with an interest in surgical training regardless of College affiliation. RCSEd’s commercial enterprises offer conferencing and event facilities at The Playfair Building, Symposium Hall and Quincentenary Hall, and runs the Ten Hill Place Hotel.